A Rare Incidence of Pigmented Villonodular Synovitis of the Ankle in an Adolescent

Pigmented villonodular synovitis mostly affects the knee and other large joints such as the hip. Although the disease is most commonly found in adult patients aged 30 to 40 years, rare cases in children and the elderly have been reported. We present the case of an 11-year-old female who was found to have biopsy-proven pigmented villonodular synovitis in her subtalar joint in 2012. Five years after surgical excision, the patient has continued to be involved in competitive dancing and cheerleading without any pain in her ankle. Moreover, follow-up magnetic resonance imaging studies showed no evidence of recurrence. Our case report emphasizes that the disease should not be solely considered in the middle-age population but should be included in the differential diagnosis of the pediatric patient.     

Haemolytic disease of the fetus and newborn: advancements in precision and prevention

In pregnant patients, the impact of blood type and the presence of red blood cell antibodies influence the course of the pregnancy and the health of the fetus and newborn infant. Throughout history, haemolytic disease of the fetus and newborn has played a fundamental role in the discovery of the blood group antibodies and their cognate antigens. The mid‐1900s were noted for the advent of Rh immunoglobulin. Now, the technological advancements in diagnosis and treatment of haemolytic disease of the fetus and newborn have provided the critical tools needed to support mothers with affected pregnancies. The knowledge of blood typing has been further refined with the explosion of understanding about blood group genes, particularly in the RH blood group. Genomic blood group typing, improvements in ultrasound technology and transfusion medicine progress have advanced the field. The care of women with potentially affected pregnancies has never been more robust. Despite this, the risk to the fetus is significant, and prevention strategies for maternal alloimmunization deserve continued attention.     

Cytomorphologic features of malignant solitary fibrous tumor with mediastinal involvement sampled by endoscopic and endobronchial ultrasound‐guided fine‐needle aspiration: A comparison of two cases

Solitary fibrous tumor (SFT) is an uncommon fibroblastic neoplasm with considerable risk of local recurrence. SFT is histologically characterized by bland spindled‐to‐epithelioid cells in alternating hyper‐ and hypocellular zones, a “patternless pattern,” ectatic “staghorn” vessels with variable edematous perivascular stroma, and thick ropey collagen. Cytologically, smears are variably cellular with spindled‐to‐epithelioid cells with oval nuclei, wispy cytoplasm, multiple inconspicuous nucleoli, and occasional nuclear pseudoinclusions. Small vessels and bare/stripped nuclei are generally present while mild atypia is not uncommon. STAT6 nuclear expression is the most useful immunohistochemical stain and is the product of a NAB2‐STAT6 gene fusion. SFTs with mediastinal involvement may be diagnostically challenging due to proximity to vital structures and anticipated patient risks. Endobronchial and endoscopic ultrasound‐guided fine‐needle aspiration (EBUS/EUS‐FNA) are minimally‐invasive tissue sampling methods that provide diagnostic material while minimizing patient risk, and the mediastinum is accessible by both procedures. Small aspirate samples and SFT nonspecific features can compound the diagnostic difficulty, although familiarity with the cytologic, morphologic, immunophenotypic, and genetic features of SFTs assist the pathologist in confirming the diagnosis. Pathologists must also be aware of high‐risk SFT features to ensure appropriate therapy and management. Case #1 describes a recurrent mediastinal SFT with high‐risk features sampled by EUS‐FNA. Case #2 describes a primary diagnosis of mediastinal SFT with malignant behavior made on an EBUS‐FNA specimen.     

Collecting verbal autopsies: improving and streamlining data collection processes using electronic tablets

Background

There is increasing interest in using verbal autopsy to produce nationally representative population-level estimates of causes of death. However, the burden of processing a large quantity of surveys collected with paper and pencil has been a barrier to scaling up verbal autopsy surveillance. Direct electronic data capture has been used in other large-scale surveys and can be used in verbal autopsy as well, to reduce time and cost of going from collected data to actionable information.

Methods

We collected verbal autopsy interviews using paper and pencil and using electronic tablets at two sites, and measured the cost and time required to process the surveys for analysis. From these cost and time data, we extrapolated costs associated with conducting large-scale surveillance with verbal autopsy.

Results

We found that the median time between data collection and data entry for surveys collected on paper and pencil was approximately 3 months. For surveys collected on electronic tablets, this was less than 2 days. For small-scale surveys, we found that the upfront costs of purchasing electronic tablets was the primary cost and resulted in a higher total cost. For large-scale surveys, the costs associated with data entry exceeded the cost of the tablets, so electronic data capture provides both a quicker and cheaper method of data collection.

Conclusions

As countries increase verbal autopsy surveillance, it is important to consider the best way to design sustainable systems for data collection. Electronic data capture has the potential to greatly reduce the time and costs associated with data collection. For long-term, large-scale surveillance required by national vital statistical systems, electronic data capture reduces costs and allows data to be available sooner.

     

Evaluation of Abortion Stigma in the Workforce: Development of the Revised Abortion Providers Stigma Scale

Objectives

We report on the development of a scale measuring abortion providers’ experiences of stigma.

Clinical Importance of Echogenic Swirling Pleural Effusions

Thoracic sonography is an important tool in diagnosis and assessment of pleural effusions and can provide valuable information about the characteristics of accumulated pleural fluid, in addition to improving the safety of thoracentesis. In addition to the 4 classic sonographic pleural effusion patterns (anechoic, complex nonseptate, complex septate, and homogeneously echogenic), an echogenic swirling pattern has been previously described, which was originally thought to be associated with malignant effusion. Two cases of pleural effusion with an echogenic swirling pattern are described below, illustrating that this sonographic finding can be seen in both exudative and transudative effusions.     

Urinary tract pacemaker cells: current knowledge and insights from nonrenal pacemaker cells provide a basis for future discovery

Coordinated ureteric peristalsis propels urine from the kidney to the bladder. Cells in the renal pelvis and ureter spontaneously generate and propagate electrical activity to control this process. Recently, c-kit tyrosine kinase and hyperpolarization-activated cyclic nucleotide-gated channel 3 (HCN3) were identified in the upper urinary tract. Both of these proteins are required for coordinated proximal to distal contractions in the ureter. Alterations in pacemaker cell expression are present in multiple congenital kidney diseases, suggesting a functional contribution by these cells to pathologic states. In contrast to gut and heart pacemaker cells, the developmental biology of ureteric pacemaker cells, including cell lineage and signaling mechanisms, is undefined. Here, we review pacemaker cell identify and function in the urinary pelvis and ureter and the control of pacemaker function by Hedgehog-GLI signaling. Next, we highlight current knowledge of gut and heart pacemaker cells that is likely to provide insight into developmental mechanisms that could control urinary pacemaker cells.